A 30-year-old woman who underwent a cesarean delivery 3 years ago reports a painful nodule over the lower abdominal scar. The pain and swelling increase during menstruation. What is the most appropriate next step?

• A Fine needle aspiration cytology followed by observation
• B Oral combined contraceptive pills indefinitely
• C Gonadotropin-releasing hormone agonist for 6 months
• D Wide local excision of the nodule ✓

Explanation

Scar endometriosis follows iatrogenic implantation of endometrial tissue during surgery such as cesarean section. It presents as a cyclical painful scar nodule. Definitive treatment is complete wide local excision with clear margins, because hormonal therapy only suppresses symptoms and recurrence follows cessation. Medical suppression may be used temporarily but is not curative, and incomplete excision is the main cause of recurrence.

Reference: Shaw's Textbook of Gynaecology, 18th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.